Provider Demographics
NPI:1265746309
Name:PHYSICAL THERAPY PROFESSIONALS
Entity type:Organization
Organization Name:PHYSICAL THERAPY PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIE
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:TINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:228-696-9946
Mailing Address - Street 1:2900 MELTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-4120
Mailing Address - Country:US
Mailing Address - Phone:228-696-9946
Mailing Address - Fax:228-696-9917
Practice Address - Street 1:2900 MELTON AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-4120
Practice Address - Country:US
Practice Address - Phone:228-696-9946
Practice Address - Fax:228-696-9917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT30682251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty